James Holland, 79, from Glanmire, Co Cork, a father of five and a grandfather of four, was pronounced dead at Cork University Hospital (CUH) in the early hours of April 11 last, Cork Coroner’s Court was told yesterday.
The inquest heard that Mr Holland, who suffered a heart attack 20 years ago, was woken by chest pains at home at around 1am on April 10. He was referred by SouthDoc to CUH and presented at its emergency department (ED) just after 3.20pm.
Dr Susan Harkin, the senior medical house officer at the time, told coroner Philip Comyn that Mr Holland was initially diagnosed with a non-ST elevation myocardial infarction — unstable angina — and a decision was made to admit him under the care of the hospital’s cardiac service.
However, he did not meet the requirements for an emergency cardiogram which was scheduled for the following day. Mr Holland remained on a trolley in a cubicle in the ED and was kept under regular observation.
Dr Harkin said she admitted Mr Holland to the hospital at 8.30pm and said while the ED was busy, a five-hour wait between presentation at ED and admission was “standard”.
Dr Heather Cronin, who was the cardiology registrar on duty at the time, said Mr Holland was awaiting a bed in one of the wards in CUH’s coronary care unit but no bed was available: “He was a priority patient but there was no bed available.”
The inquest was told Mr Holland was noted to have stable heart rhythms at 11.10pm, but that he was found unresponsive at 12.45am . Despite extensive resuscitation efforts, he was pronounced dead at 1.20am. The inquest was told he had suffered a pulseless electrical activity cardiac arrest.
Consultant cardiologist Dr Ronan Curtin told the coroner that while this type of cardiac arrest occurred in up to 30% of cardiac arrest incidents, it cannot be detected by hospital heart monitors.
He said in this case, the wall-mounted heart monitor in the ED cubicle which was monitoring Mr Holland’s cardiac output would have detected normal cardiac electrical activity but would not have identified the absence of cardiac output, and would therefore not have sounded an alarm.
“The event [cardiac arrest] is relatively silent. It happens in a split second — it’s immediate,” he said.
And he said while the HSE has target times for patients under 80 to spend no longer than 24-hours on a trolley, the care received by a patient on a trolley is generally the same as the care they would receive in a ward: “It’s still a relatively long time to be on a trolley.” But he said doctors treat the patient first and worry about beds after.
Assistant state pathologist Dr Margot Bolster said a post mortem established that the cause of Mr Holland’s death was sudden cardiac death.
Mr Holland’s legal representative applied for an adjournment after his family disputed claims he was attached to a heart monitor before 8.30pm on April 10. But the coroner said he had enough evidence to record a verdict of death due to natural causes.